Provider Demographics
NPI:1801074877
Name:WRINKLE RESPIRATORY AND DME INC. DBA SLEEP TECHNOLOGIES LTD
Entity type:Organization
Organization Name:WRINKLE RESPIRATORY AND DME INC. DBA SLEEP TECHNOLOGIES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:503-496-5239
Mailing Address - Street 1:PO BOX 30151
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72260-0003
Mailing Address - Country:US
Mailing Address - Phone:503-496-5239
Mailing Address - Fax:503-343-6554
Practice Address - Street 1:1 OTTER CREEK CIR STE C
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-1680
Practice Address - Country:US
Practice Address - Phone:503-496-5239
Practice Address - Fax:503-343-6554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP TECHNOLOGIES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
AR306516-60-001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR60488OtherACHC ACCREDITATION
AR211292737Medicaid
AR184800716Medicaid